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HomeMy WebLinkAbout17403 (25) _ .� �` C1TY OF I3IAMONB BAR � �� ��� ---�'�---- DEPAR'I'1v�ENT OF COMIvIUNITY&DEVELOPMENT SERVICES ` " I � �' ` ,/ 21825 E.Copley Drive �. � � �j I ' �`�" {909)860-3195 Fax(909)861-3117 } � PRESS ' \vri�'��' BiJIII;�INGPERMITAP'PLICATION ��""""��r� FIRMLY � JOBSITE r�-� � ��n) ��� '`�^�,` APPLICATION PERMIT �j P/C � ADDRESS C3 /�' J]! a� �� DATE � `�� � NUMBER ��# oro ISSUE TYPE ,i OCC APN LOT TRACT DATE � CONST.�GROUP p OWNER ��,.#`-��_��- ADDRESS ZONING SETBACKS z CITY ZIP TEL � ' FRONT RW ❑ � APPLICANT �=�--`�'���F..0 TEL. %W �-� REAR ❑ ' � SIDE/SIDE STREET RW ❑ �� Q CONTRACTOR I^' �- j � �A L SIDE ❑ : � P;DDRESS � ' � PROPOSED USE � � �'r K ��' � GITY ZIP� �� w ARCHlENG/ o �',b ' � � �, �;y� p� z DESIGNER__ /� � ADDRESS ��7 � � _ NO.DWEL. NO. NO. ���� � CITY ZIP TEL. UNITS STORIES BEDROO � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � O� OV�MER-6UILDER DECLARATION SFR/ADD/REM . Q I HEREBV AFFIRM UN�ER PENALTV OF PERJURY THAT I AM EXEMPT FROM THE CONTPACTORS LI- � GaragelCarport ' W ' CENSEtAWFORTHEFOLLDWINGREA50N(SEC.7037.59USINESSANDPROFESSIONSGODE:ANYCITYOfl � V COUNTYWHICHHEQUIfiESAPEflM,IYTOCONS'ffll1CT.ALTER,IMP,90VE.DEMOLISH,ORREPAIFANYSTflUC- W PafiO/�BCk Z iUpE,PRIOR TO ITS ISSUANCE,ALSO REQIJIRES THE APPLICANT FOfl S�CH PERMIT TO FILE A SIGNED w � � STATEMEMT THAT HE OR SHE'IS LICENSED PURSUAN7 TO THE PROVISIONS OF THE CONiRACTORS LI- I � CENSE LAW(CHAPTER e(COAAMENCING WITH SECTION�000)Of DIVISION 3 OF iHE BUSINESS AN�PRO- � PooVSpa FESSIIXJS�E)OFTMATHEORSNEISEXEMP?THEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- � ���� 710N.ANYVIOLATIONOFSECTION,7o31.6BVANYAPPLICAMTFORAPERMITSUBJECTSTHEAPPLICANiTO �z Re-Roof ���.�� A CIVIL PENALTY OF NOT MOftE TF{AN FNE HUN�REU DOLLARS($500).): �� ❑I,ASOWNEROFTHEPROPERIY,ORMVEMPLDYEESWITHWAGESASTHEIfiSOLECOMPENSATION, ❑ Commercial -� WILL DO THE WORK,AN�THE'STRIICTUPE IS NOT INTENDEO OF OFFERE�FOFi SALE(SEC.7044.BU51- J NE55 PND PPOFESSIDNS CODE:THE CONTftACTORS LICENSE LAW DOES NOT APPLY TO pN OWNER OF N' PflOPERTYWH081JILD50RIMPROVESTHERcON,AN�WHO�OESSUCHWORKHIMSELFORHERSELFDR m � (,L',� TMROUGHHISORHEflOK7JEMPLOYEES,PROVIDEDTHA75UCHIMPROVEMENTSARENOTINTENDEDOR w'' OFFEREDFORSALE.IF,HOWEVER,THEBUIL�INGORIMPROVEMENiISSOLOWITHINONEYEAROFCOMPLE- . TION,THE OWNER-BUIL�ER WILL HAVE THE BUR�EN OF PRDV%NG TNAT Y.E OR SHE pID NOT BUI'�_D OR �'.'� IMPHOVE FOR THE PURPOSE OF S�ALE).�, fl I,AS OWNER OF THE PROP�ftTY,AM E%CLUSNELYCONTRf CTING WITH LICE�SED CONTRACTORS Q�,' TO CANSTRUCT THE PROJECT-(SEC.7044,B�SINESS AN�PROFc5510NS CADE:h1E CONTFACTORS LI- VBIUStI0Y1 ADJ.AREA W'�.. CENSELAWDOESNOTAPPLYTOAN�WNEROFAPROPERTYWHOBLII(DSORIMPROYESlMER"eON.AN� F��.� WHCICONTRACTSFORSUCHPROJ,ECTSWITHACONTRACTOR��)LICENSEOPURSUANTTOTHECONTRAF QUANTITY DESCRIPTION FEE � � 70RSLICENSELAW.). � ��' ❑I AM EXEMPT UNDEii SEC.� B,4 P.C.FOR THIS REASON U � � V"� DA?E ' 'OWNER ~ W �� LICENSED CONTRACTOR5 DECLARATION W ¢ ; � INEREBYAFFIRMUNDERPENALTYOFP�RJURYTHA7IAMLICENSEDUNDEPPROVISIONSO%CHAPTER � - d.. 9(COMMENCING WfTH SECTION 7doo)OF DIVISION 30FTHE BUSINESS AND PROFESSIONS CO�E,AND Z . K, MY LICENSE IS IN FULL FORCEAND EFFECT. LlJ �. . � ,) � �„ LICENSEG 55 9n LIC.NO._�� �J V DATE � CONTRACTOR '�_=� d W � WORKERS'COMPENSATION DECLARATION � � I HEREBVAFFIRM UPIDEq PENALTYOF PERIURV ONEOFTHE FOLLOWING DECLARqTI�NS: � �' Z Q � _IHAVEAN�WILLMABJTAIN'�.ACERTIFICATEOKCONSENTTOSELFINSVREFORWORKERS' _ . Z� CAMPENSATION,ASPROV�DEDBVSECTION3]ooOFTHELABORCO�E,FORTHEPERFORMANCE U ¢ OFTHEWORKFORNHICH'THISPERMIT15155UED. � W i _I HAVE AN�WILL MAIMAIN'WORNERS'COMPENSATION MSURANCE,AS REOUIRED BV SECTION 0 Q , Q.,. 37Gu DF THE LABOR CDOEj FOR THE PERFORMANCE OF THE WORK FOR WNICH THIS PERMIT IS N ISSUED.MY WORK 5' PENSATION INSUftANCE CAflPIEFiAND POL�CY NUM@ERARE: CONSTRUCTION b �t cn,RaiER�j�^�.- ��.ev� PLANREVIEW ? ,�E 6 2 POLICY NUMBER � j �4 9'S�� "� C�� ELECTRIC a (MISSECTIONNEmNOTBECObiPLEfEooFTHEPERMITISFORONEHUf�DREDD011AR5(5100)ORLE55). PLUMBING O Z�'. 1 CERTIFY7HAT IN iHE PE�FORMANCEOFTHE VlORK FOR WHICHTHIS PERMIT IS ISSUED,I MECHANICAL �J' „ SHALLNOTEMPLOYANYPERSONINANYlAANNEHSOAST BECOMESUBJECTTO7HE �' WORKERS'COMPENSATIO�ML4WSOFCALIFORNIA,AN� EETHATIFISHOl1LDBECOME ,..JNSPECTIONFEE _q.�.-a Gy_� _�, SUHJECT TO THE WOflKE�5'COtAPENSATION PPOVISI S O S, I 370o OFTHE LABOR �ti��' CODE, HPLL pflTHWITI�COMPLYWITHTHOSEP IS � I• ISSUANCE 'GJ�bi�O �� q �' I SMIP P �� ��,'. DATE: �I .� ApPLICANT. �", WAflNING FAILURE Td SECURE WOi7kER5'COM SA RAGE IS UNLAWFUL,AND SHALL eE ENERGY P/C � '� SIPdJECTAN EMPLOYERTOCRIMIf�AL PENALT AN I ES UP TOONE HUNDREO THOUSANO ENERGY PERMIT . DOLLARS(5100,000),IN ADDITION T THE'C OF iION,�FMAGESAS PROV!DE�FOR IN y � �; �SECTION37080FTHELABORCO��MTE ST,A uersFEes. RETENTIONFEE: T � O, CO�ST UCTIO LENDING AGENCY PRE-ALT FEE: Q„ IHEREBYAFFIRMUNDEflPEttlALNIOFP=ftJURVTHATTHEFEISACONSTflUC710NLEN�INGAGENCY _ FOR THE PERFORMANCE OF THE WORK FOF WHICH iH15 PEqMR IS ISSUEO(SEC.309],dV C.). � W S� LENDER'SNAME � ' F- LENDER'SADORESS � �� � r ��7 � ICERTIFYiHATIHAVEREADTHISApPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTALfEES ��'YC � � � IAGREETOCOMPLYWITFiALLCITYAN�GCUNTYORDINANCESANDSTATELAWSRElAT1NGTOBUILDING � CONSTAUCTIDN,ANOHEREBVAViHORIZE?�EPRE ENTAiIVE50FTHI5COUN7YTOENTERUPONTHe A80VE�MENTIDNEDPROPERTYFOYiINSPECTION UflPOSES. 2 �. COMMENTS__._. ��, ���� ��� , � � — m PERMITTEENAME IN @. �', Uj''� SIGNATU 1 E � DATE S � RECPT.NO. PAID BY VALIDATION ~ �� WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy.GOLDENR06—File Copy,GREEN—ApplicanPs Copy . � $ '#�r �� E e. � S a . , n°A'��"rc�. ,. � .. . £..� , 3 , . 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